January 30, 2018

expert reaction to brain pacemaker for Alzheimer’s

Researchers look at deep brain stimulation of frontal lobe networks to treat Alzheimer’s disease in a new study published in the Journal of Alzheimer’s disease.

Dr Mark Dallas, Lecturer in Cellular and Molecular Neuroscience, University of Reading, said:

“Tapping into the brains electricity has been used as a treatment option for Parkinson’s disease, there are on-going studies looking at its suitability for alleviating different aspects of Alzheimer’s disease. This is a small study, only looking at 3 brains, which limits the impact of this study in terms of what it can tell us about its use as a future therapy.”

“This paper shows data from a team using deep brain stimulation to try and slow the decline of problem solving and planning skills in people living with Alzheimer’s disease. Three people had an electrode surgically implanted in the frontal lobe of their brains, which sent patterns of electrical activity to these brain structures. The surgery and stimulation were safe in this small study. While the results reported here bode well for the safety of deep brain stimulation in this part of the brain, the study is too small to draw conclusions about whether this will be a useful therapy and this study lacks the necessary control group of people who had the surgery but did not receive stimulation. In a previous study, a randomised control trial of deep brain stimulation to a part of the brain important for memory failed to slow memory decline.”

“Deep brain stimulation (DBS) is a well-established treatment which can reduce symptoms of Parkinson’s disease and it has previously been tested in similar way for Alzheimer’s disease, with varying results.

“DBS involves surgically implanting electrodes into the brain to stimulate remaining brain cells where their partner cell has died. While this approach could provide a different avenue for symptom management than drug treatments, the technique has to be adapted for each individual which as we have learned from Parkinson’s can be very complex.

“This study showed that DBS is likely to be safe for people with Alzheimer’s disease but as the study only involved three people who showed varying degrees of improvement, it may not work for everyone in practice. It is also important to highlight that though DBS could help a person to manage symptoms of Alzheimer’s, there is no evidence to suggest that it slows down or prevents brain cell death.

“Given that we haven’t had any new treatments for dementia in over a decade it’s encouraging to see techniques from other diseases being tested for dementia, but it will need further, more in depth research before we can draw any firm conclusions.”

Dr Carol Routledge, Director of Research at Alzheimer’s Research UK, said:

“Deep brain stimulation is already used as a treatment to reduce severe tremors in Parkinson’s and it is encouraging to see this exploratory study in people with Alzheimer’s disease. Previous research with deep brain stimulation in Alzheimer’s has shown mixed results, but studies have not focused on brain regions responsible for decision making and problem solving before. While memory is a key problem in Alzheimer’s, changes in thinking skills have an equally devastating impact so it’s important that treatment approaches address these symptoms too.

“This small phase I trial is useful in demonstrating that this invasive treatment is safe and has no serious side effects in Alzheimer’s, but the observed benefits in two of the patients must be treated with caution. The study did not compare against a dummy treatment and so while signs of benefit are worthy of follow-up, the full benefits and cost-effectiveness of this treatment need much more robust investigation in larger trials.

“There is a large amount of ongoing research to develop new drug treatments for dementia, but it’s important that research also explores non-drug avenues of treatment. With 50 million people in the world living with dementia today, it is vital we continue to invest in a broad range of approaches to improve people’s lives.”

Prof. Robert Howard, Professor of Old Age Psychiatry, UCL, said:

“This study has not shown that deep brain stimulation can slow down or improve cognitive and functional decline in Alzheimer’s disease. It has shown (albeit in a small sample of 3 patients) that deep brain stimulation appears to be safe and well-tolerated in people with Alzheimer’s disease.

“Claimed benefits are most likely placebo effect. Before we can draw any conclusions about efficacy or usefulness of deep brain stimulation, randomised placebo-controlled trials need to be performed within which larger numbers of participants are randomly allocated to deep brain stimulation or placebo (most likely an implanted stimulator that isn’t switched on or that stimulates at an ineffective frequency) and participants, their clinicians or trial assessors are unaware of individual treatment allocations.”